Subclinical cardiovascular disease in patients with chronic obstructive pulmonary disease: a systematic review.

BACKGROUND: Cardiovascular disease (CVD) accounts for a significant portion of deaths in patients with COPD; however, evidence for early detection strategies for CVD in this population remain limited. Our paper aims to summarize existing data regarding subclinical CVD in patients with COPD with a view to identifying screening strategies in these patients. METHODS: A systematic review of published literature was conducted for studies examining the relationship of COPD and markers of subclinical disease such as coronary artery calcification (CAC), carotid intima media thickness (cIMT), endothelial dysfunction, arterial stiffness as measured by pulse wave velocity (PWV) and augmentation indices (AIx). Both MEDLINE and EMBASE databases were searched till October 2015. RESULTS: A total of 22 studies were included in the review. Compared with control subjects, patients with COPD had significantly higher cIMT (SMD 0.53, 95% CI 0.16-0.90), PWV (SMD 0.91, 95% CI 0.67-1.16) and AIx (SMD 0.86, 95% CI 0.52-1.19). Additionally, an overall higher prevalence of subclinical CVD as assessed by CAC, ABI and FMD was noted in our review. CONCLUSION: Although our findings need further evaluation in prospective studies, our review presents significant evidence in support of increased subclinical CVD burden in COPD patients independent of smoking status. Further large-scale case-control studies are required to highlight the significance of subclinical CVD screening in COPD patients.

Integration of computers and related technologies into deaf education teacher preparation programs.

The study examined how computer technology is used, modeled, and taught in programs that prepare future teachers of students who are deaf or hard of hearing. Data were collected through two self-reported survey instruments sent to participants from two different groups: (a) deaf education faculty (n = 233) and (b) administrators of programs serving students who are deaf or hard of hearing (n = 100). Among the faculty who responded to the survey, 99% said they used computers and printers for instruction during class, 84% said they used VCRs for instruction during class, and 56% said they used video cameras for instruction during class. The information that was reported on how technology was being used for instruction and how its use was being taught to students in deaf education teacher preparation programs indicates that the need persists for integration of technology into these programs. A need likewise continues for improved instructional strategies relative to computers and technology.

Objective measures of joint stiffness.

Objective measures of joint stiffness allow for the evaluation of the effectiveness of treatment modalities. Without this, the effectiveness of therapy is not quantifiable. Presently, joint stiffness can be quantified by either passive range of motion (PROM) measurement or torque range of motion (TqROM) measurement. PROM measurement does not control the force applied, nor does it require that the other joints in the kinematic chain be held fixed. Also, it demonstrates poor interrater reliability. An idealized device melding existing technologies of constant passive motion devices and computerized workstations is proposed to allow for easier measurement of TqROM angles for analysis data for the determination of the effectiveness of treatment modalities.

Evaluating evaluation: assessment of the American Board of Internal Medicine Resident Evaluation Form.

The American Board of Internal Medicine suggests use of a standard form to rate residents on nine dimensions (such as clinical judgment and overall clinical competence) on a scale of 1 to 9. The authors examined the psychometric evidence for reliability and validity of 1,039 ratings of 85 residents by 135 attendings in a single internal medicine residency program. Of these ratings, 95.6% were from 6 to 9. Factor analysis revealed that high correlations among the nine dimensions (r ranged from 0.72 to 0.92) resulted from a single global factor accounting for 86% of the variance. The study also examined whether the form reliably distinguishes among residents scoring between 6 and 9. Agreement among attendings rating the same individual was weak (average reliability = 0.64, by the method of James). The rating method fails to discriminate dimensions of clinical care and has low reliability for distinguishing among competent residents.

Measuring affect at work: confirmatory analyses of competing mood structures with conceptual linkage to cortical regulatory systems.

Twenty so-called clear markers of positive and negative mood (Watson & Tellegen, 1985) were applied in the current study to measure affect at work. Confirmatory factor analyses of a bipolar Two-Factor (i.e., positive and negative affect) Model and a competing multifactor model were conducted with three samples: managerial and professional workers in an insurance firm, retail sales personnel, and a heterogeneous group of students who were employed. The first-order Two-Factor Model (i.e., descriptively bipolar positive and negative affect factors) hypothesized to underlie the 20 affect items did not provide a strong fit to the data in the three samples. A first-order Four-Factor Model with descriptively unipolar factors labeled as Positive Arousal (Enthusiasm), Negative Activation (Nervousness), Low Arousal (Fatigue), and Low Activation (Relaxation) provided a better fit across the samples. These results support the measurement of positive and negative mood as descriptively unipolar factors. The measurement implications of these results as well as conceptual linkages between the four mood factors and the two major cortical regulatory systems, left-lateralized dopaminergic activation and right-lateralized noradrenergic arousal, are discussed.

Linking clinical dietetic practice with educational development in Tennessee.

Does the setting for health care delivery affect the development of competence in clinical dietetics? A survey was conducted to compare clinical dietetic practice in hospitals and in public health agencies in Tennessee. It was found that the nature of practitioners--their demographic characteristics, credentials, and roles in practice--could not be differentiated. There was, however, a difference between groups when the high-priority counseling performance situations (problem-solving encounters) were compared, suggesting that there is a difference in competence needed for clinical dietetic practice. A Delphi probe was conducted among educators and practitioners in Tennessee to identify anticipated priorities among clients' needs and problems in future counseling intervention without regard to the setting for health care delivery. In clinical education, selecting a general set of performance situations representative of practice in a variety of settings enables practitioners to develop breadth of competence. Future practitioners need to be able to modify and create roles to address societal needs and expectations in systems not yet envisioned. The articulation of dietetic and public health nutrition education programs that have a common purpose is a step in that direction.

Reversal of Fv-1 host range by in vitro restriction endonuclease fragment exchange between molecular clones of N-tropic and B-tropic murine leukemia virus genomes.

We molecularly cloned unintegrated viral DNA of the BALB/c endogenous N-tropic and B-tropic murine leukemia retroviruses and in vitro passaged N-tropic Gross (passage A) murine leukemia retroviruses. Recombinant genomes were constructed in vitro by exchanging homologous restriction enzyme fragments from N- or B-tropic parents and subsequent recloning. Infectious virus was recovered after transfection of these recombinant genomes into NIH-3T3 cells and cocultivation with the Fv-1 nonrestrictive SC-1 cells. XC plaque assays of recombinant virus progeny on Fv-ln and Fv-lb cells indicated that the Fv-l host range was determined by sequences located between the BamHI site in the p30 region of the gag gene (1.6 kilobase pairs from the left end of the map) and the HindIII site located in the pol gene (2.9 kilobase pairs from the left end of the map).

A survey of undergraduate programs for the community practitioner.

The purpose of the survey of college and university undergraduate programs in community nutrition, community dietetics, and public health nutrition was to characterize undergraduate programs which prepared entry-level practitioners in order to facilitate planning at the graduate level. The survey, which sampled known problems areas, revealed the diversity, confusion, and accomplishments of a field of study that is changing. The rapid growth and early stage of development of many of the undergraduate programs suggested that measures may be taken to promote excellence in both undergraduate and graduate education. Specific problems in the organization, administration, and curricula of the programs surveyed were identified. Recommendations were made to the Association of Faculties of Graduate Programs in Public Health Nutrition and the State and Territorial Public Health Nutrition Directors to promote surveillance of these programs, to encourage problem-solving communications, and to conduct educational research. The report and the recommendations have been referred to the newly formed ad hoc committee of the joint associations for further action.

Protein-metal ion interaction: volume effects produced by the interaction of proteins with metal ions.

The interaction of metal cations with single chain globular proteins produces volume increases, the magnitude of which is determined primarily by the ion and to a lesser extent by the protein. The cations are listed in ascending order of volume change: K(I) less than Mg(II) less than Sr(II) less than Ca(II) less than Co(II) less than Ni(II) less than Cd(II) less than Zn(II) less than Cu(II) less than Pb(II). This sequence held for all cation-protein systems investigated except for Cd(II) which produced a slightly larger volume effect than Zn(II) with lysozyme. The volume changes attributed to protein-cation interaction are positive and range from 8 ml/10(5) g of protein for the reaction on 0.05 M KNO3 with bovine plasma albumin to 2320 ml/10(5) g of protein produced by the 0.20 M Pb(NO3)2-myoglobin system. A similar classification scheme was not possible for the proteins. For example, volume increases of 45, 50, 80 and 95 ml/10(5) g of protein were produced when 0.05 M Mg(II) reacted with bovine serum albumin, ovalbumin, sperm whale myoglobin and lysozyme, respectively. However, when 0.2 M Pb(II) was the reactant the values were 1930, 846, 2320, and 1120 ml/10(5) g of protein. Volume effects produced by Cr(III), Al(III) and Fe(III) were determined, but the calculated results are considered dubious because the volume changes are a complicated function of protein-cation and protein-proton interaction.

Autogenous immunity to endogenous RNA tumor virus. Identification of antibody reactivity to select viral antigens.

The viral antigenic determinants recognized in an autogenous immune response in mice against their endogenous C-type virus have been identified by SDS-polyacrylamide gel electrophoresis of immune precipitates between various sera and H(3)-labeled intact or disrupted AKR leukemia virus. Normal B6C3F(1) [(C57BL/6 x C3H/Anf)F(1)] serum reacts with viral envelope antigens having mol wt of approximately 68,000, 43,000, and 17,000. In addition, minor reactions with viral antigens having mol wts of approximately 19,000 and 15,000 are demonstrable. The 68,000 and 43,000 mol wt antigens can be labeled with [(3)H]glucosamine and may correspond to the major viral envelope antigens M(2) and M(1), respectively. The antigens recognized by autogenous immune sera do not differ with respect to age of the animal, nor are they significantly different in sera from various strains of mice (BALB/c, C57BL/6, and C3H/Anf). These results suggest that the age-asociated and strain variations in the autogenous immune response, as determined by radioimmune precipitation assays against intact virus, are due to quantitative and qualitative alterations of antibody levels against common antigens.